Bmw management

Notes on biomedical waste management

1. BMW MANAGEMENT
-Dr. RAVIKIRAN H M

Defined as “any solid, fluid and liquid or liquid waste, including its container and any
intermediate product, which is generated during the diagnosis, treatment or immunization of
human being or animals, in research pertaining thereto, or in the production or testing of
biological and the animal waste from slaughter houses or any other similar establishment”.
All biomedical wastes are hazardous.

Hospital Waste Composition
• Paper: 15%
• Plastic: 10%
• Rags: 15%
• Metals (Sharps, etc): 1.0%
• Infectious waste: 1.5%
• Glass: 4.0%
• General waste (food waste, sweeping of premises): 53.5%

In fact, only 15% of hospital waste (not whole of the waste) i.e. “Biomedical waste” is
hazardous. But when hazardous waste is not segregated at the source of generation and mixed
with nonhazardous waste, then 100% waste becomes hazardous.

Need of BMW:
The need or rationale for spending so many resources in terms of money, manpower, material
and machine for management of hospital waste are due to following risks:

2. 1. Injuries from sharps leading to infection to all categories of hospital personnel and waste
handlers.
2. Nosocomial infections in patients from poor infection control practices and poor waste
management.
3. Risk of infection outside hospital for waste handlers and scavengers and at times, general
public living in the vicinity of the hospitals.
4. Risk associated with hazardous chemicals and drugs to persons handling wastes at all levels.
5. Risk of recycling of “Disposables” which are being repacked and sold by unscrupulous
elements.
6. Risk of spurious drugs due to repacking of disposed off drugs to unsuspecting buyers.
7. Risk of air, water and soil pollution directly due to waste, or due to defective incineration,
emissions and ash


Steps in the management of biomedical waste include:
a. Generation
b. Segregation

3. c. Collection
d. Storage
e. Treatment
f. Transport
g. Disposal.

Biomedical Waste Management (BMW) in India
• Biomedical Wastes (BMW) in India are handled and managed under ‘Biomedical Waste
Management (Management and Handling) Rules, 1998’
–– Exercising powers: Sections 6, 8, 25 of ‘Environmental (Protection) Act, 1986’ (under the
Ministry of Environment and Forests)
• Schedules under Biomedical Waste Management (Management and Handling) Rules, 1998:
–– Schedule I: Categories of BMW, treatment and disposal
–– Schedule II: Color coding and type of container for BMW disposal
–– Schedule III: Labels for BMW containers/bags
–– Schedule IV: Label for transport of BMW containers/bags
–– Schedule V: Standards for treatment and disposal of BMW
According to Bio-medical Waste Management Rules, 2016, the Central Pollution Control Board
and the State Pollution Control Committees have the authority to cancel the consent to operate
and the authorization of healthcare institutions, for non-compliant hospitals. Indeed, there have
been such instances in India.

Categories of Biomedical Wastes (BMW) (Schedule I)

4. Treatment/Disposal of Biomedical Wastes (Schedule I)


Colour Coding and Type of Container for BMW Disposal (Schedule II)

5. BMW Management Treatment Modalities
1. Mechanical Processes: compacting, shredding, encapsulation, inertization
2. Thermal Processes: Heat disinfection, Hot air oven, Autoclave, Hydroclave, Microwave,
Incineration, Plasma arc, gamma irradiation
3. Chemical Processes: Disinfectants, Antiseptics
4. Biological Processes: Composting, Vermi-composting, bio-digestion

1. Mechanical Processes
• Compacting: Reducing size and volume of waste (Useful for general non-hazardous
wastes)
• Shredding: Breaking the material into smaller pieces by grinding/cutting/ granulation
(Useful for plastics, rubber and soft metals)
• Landfill: Oldest method of waste disposal
–– Two types: Open dump or Sanitary landfill
• Encapsulation: Filling containers with waste, adding an immobilizing material (plastic
foam/bituminous sand/cement mortar/clay material) and sealing containers.
• Inertization
• Process: Mixing biomedical waste with cement and other substance before
disposal, so as to minimize risk of toxic substances contained in waste to
contaminate ground/ surface water.
–– Inertization is especially suitable for pharmaceuticals and for incineration
ashes with high metal content

6. • A typical composition of mixture is:
–– 65% pharmaceutical waste
–– 15% lime
–– 15% cement
–– 5% water
2. Thermal Processes
• Heat disinfection: Boiling for 20 minutes
–– Useful for pre-treatment of sharps and plastics waste
• Hot air oven: Causes sterilization and mutilation at 160°C
–– Used for glassware, powders and oils impermeable to steam
• Autoclave: Steam-sterilization under pressure is a low-heat thermal process
–– Waste is subjected to 121°C or 135°C
• Hydroclave: Steam-sterilization under pressure causes fragmentation of wastes
–– Waste is subjected to 121°C or 132°C
• Microwave: Volumetric heating for microbial hazardous wastes using frequency of
2450 MHz and wavelength 12.24 nm
–– Waste destruction occurs by „heat conduction‟
• Incineration: High temperature dry oxidation process which reduces waste volume and
weight
–– Waste is subjected to 850 + 50°C and 1050 ± 50°C
• Plasma arc: Ionized gas (electrical discharges) at high temperature causes gasification
and molecular dissociation of organic wastes
–– Waste is subjected to 2000°C
• Gamma irradiation: Useful for re-usable medical equipments and clothing.
3. Chemical Processes
• Disinfectants: A disinfectant is a chemical agent, which destroys or inhibits growth of
pathogenic micro-organisms in the non-sporing or vegetative state
–– Disinfectants are applied to inanimate objects and materials such as
instruments and surfaces to control and prevent infection.

7. • Antiseptics: An antiseptic is a type of disinfectant, which destroys or inhibits growth of
micro-organisms on living tissues without causing injurious effects when applied to
surfaces of the body or to exposed tissues.
4. Biological Processes
• Composting: Land and cow dung (gobar) are used
• Vermi-composting: Earth worms (Eisenia foetida), land, matured cow dung (khad) and
coconut husk are used
–– Not useful for non-biodegradable wastes
• Bio-digestion: Biodegradable kitchen waste or left over food of a hospital is used, which leads
to production of manure and methane
–– Useful for rural heath care institutions.

Incineration
• Is a ‘high temperature dry oxidation’ process; It leads to significant reduction in waste-volume
and weight (up to 70-80%)
–– Incineration does not require pre-treatment
–– Biggest disadvantage of incineration: Generation of smoke
• Types:
–– Double-chamber pyrolytic
–– Single-chamber pyrolytic
–– Rotary kilns
• Temperature in an incinerator:
–– Primary chamber: 800° ± 50°C
–– Secondary chamber: 1050° ± 50°C
• Characteristics of wastes suitable for incineration:
–– Low heating volume
–– Combustible matter > 60%
–– Non-combustible solids < 5%
–– Non-combustible fines < 20%
–– Moisture content < 30%
• Wastes types not-to-be incinerated:

8. –– Pressurized gas containers
–– Reactive chemical wastes (large)
–– Silver/Radiographic/photographic wastes
–– Halogenated plastics (PVC)
–– Wastes with high mercury/cadmium content
–– Sealed ampoules ampoules with heavy metals.
–– Sharps
–– Cytotoxic drugs

Mercury disposal
• Dispose mercury as a hazardous waste
• „Never combine it with organic or inorganic waste
• Never dispose it in sink/drain
• Dispose off in „Recycling units‟

9. Schedule I of 2016 contains details of Bio-medical Waste categories and their segregation,
collection, treatment, processing and disposal options.
Part 1: Bio-medical waste classified into 4 categories based on treatment options
Part 2:
1. Chemical treatment should be done using at least 10% sodium hypochlorite
having 30% residual chlorine for twenty minutes. But as per BMW
(amendment) rules, 2018, 1% to 2% sodium hypochlorite should be used.
2. There is no need of chemical pre-treatment before incineration, except for
microbiological, lab and highly infectious waste.
3. Syringes should be either mutilated or needles should be cut and or stored in
tamper proof, leak proof and puncture proof containers for sharps storage.
Schedule II: Standards for treatment and disposal of BMW
Schedule III: Prescribed Authorities and corresponding duties
Schedule IV:
Part A: LABEL FOR BIO-MEDICAL WASTE CONTAINERS OR BAGS
Part B: LABEL FOR TRANSPORTING BIO -MEDICAL WASTE BAGS OR
CONTAINERS

11. Salient features of BMW Management Rules, 2016 along with Bio- Medical Waste
Management (Amendment) Rules, 2018
1. The scope of the rules has been expanded to include vaccination camps, blood donation
camps, surgical camps or any other healthcare activity.

12. 2. Phase-out the use of chlorinated plastic bags, gloves and blood bags within two years of
notification of BMW management 2016 rules i.e. by 27th March, 2018. But as per the Bio-
Medical Waste Management (Amendment) Rules, 2018, use of chlorinated plastic bags
(excluding blood bags) and gloves has to be phased out by the 27th March, 2019.
3. Pre-treatment of the laboratory waste, microbiological waste, blood samples and blood bags
through disinfection sterilization on-site in the manner as prescribed by WHO or NACO.
4. Provide training to all its health care workers and immunize all health workers regularly
against diseases like tetanus and Hepatitis B.
5. Establish a Bar-Code System for bags or containers containing biomedical waste for disposal
within one year of notification of rules i.e. 27th March, 2017. But as per the Bio-Medical Waste
Management (Amendment) Rules, 2018, bar-code System has to be established in accordance
with the guidelines issued by the Central Pollution Control Board by 27thMarch, 2019.
6. Report major accidents like needle stick injuries, broken mercury thermometer, accidents
caused by fire, blasts during handling of biomedical waste and the remedial action taken and
record the same in Form I (Annexure I).
7. Procedure to get authorization is simplified.
8. The new rules prescribe more stringent standards for incinerator to reduce the emission of
pollutants in environment.
9. No hospital/ healthcare facility (occupier) shall establish on-site treatment and disposal
facility, if a service of “common bio-medical waste treatment facility‟‟ (CBMWTF) is available
at seventy-five kilometers.
10. Operator of a common bio-medical waste treatment and disposal facility to ensure the timely
collection of bio-medical waste from the healthcare facility and assist the healthcare facility in
conducting training.
11. Bio-medical waste has been classified into 4 categories instead of 10 categories as per
Biomedical Waste (Management & Handling) Rules, 1998 to improve the segregation of waste
at source.

13. COVID19:

14. Reference:
Vivek Jain PSM
BMW-GMCH, Chandigarh
Health & Family Welfare
Form - Accident reporting
1. Date and time of accident:
2. Type of Accident:
3. Sequence of events leading to accident:
4. Has the Authority been informed immediately:
5. The type of waste involved in accident:
6. Assessment of the effects of the accident on human health and the environment:
7. Emergency measures taken:
8. Steps taken to alleviate the effects of accidents:
9. Steps taken to prevent the recurrence of such an accident:
10. Does you facility has an Emergency Control policy? If yes give details:
Date: …………………… .. Signature …………………….
Place: ………………………. Designation........................

15. Table 1: label